Commentary from James T. Mulder - Healthcare writer - New York State.

Commentary from James T. Mulder - Healthcare writer - New York State.

Syracuse, N.Y. -- Nurse practitioners in New York will be able to operate more independently of doctors under a bill slated to become law as part of the state budget enacted this week.

The Nurse Practitioners Modernization Act will remove the requirement of a written practice agreement between an experienced nurse practitioner and a doctor as a condition of practice. The law will take effect Jan. 1, 2015.

Seventeen other states and Washington, D.C., have already done this.

The state Medical Society and doctors groups at the federal level have adamantly opposed efforts to give nurse practitioners more independence. They cite concerns over patient safety and quality of care because nurse practitioners do not have as much training as doctors.

But there's research that suggests there's little difference in the quality of care provided by nurse practitioners and doctors. Nurse practitioners say they want to operate more independently so they can pick up some of the slack created by a growing doctor shortage.

Nurse practitioners can diagnose and treat illnesses, prescribe drugs and do many of the same things doctors do. A nurse practitioner is a registered nurse who has received a master's degree and training in a specialty area such as primary care.

In a prepared statement, Denis Tarrant, president of Nurse Practitioner Association of New York State, said the law "will ensure that New Yorkers will have access to high quality health care."

You can contact health writer James T. Mulder at jmulder@syracuse.com or (315) 470-2245. Follow him on Twitter @JamesTMulder

New York State NP Modernization Act

April 1, 2014 - Nurse Practitioner Modernization Act Passes with NYS Budget

The new law is a result of enormous efforts the Governor, the Senate and the Assembly, as well as with The NPA leadership and volunteers.   There were many outside forces attempting to derail The NPA's efforts to eliminate the onerous and outdated requirement for having a signed Written Practice Agreement as a matter of law.  Failure to accept certain changes to our initial proposal would have resulted in the continuation of the arcane requirement.  The cooperation among the Legislature, Executive, and The NPA led to the enactment of legislation that truly enhances the nurse practitioner profession in New York State.  This new law removes the requirement of a written practice agreement between an experienced nurse practitioner as a condition of practice. Leaders of The NPA have heard countless instances of nurse practitioners around the state losing their collaborating physician through no fault of their own or desiring to operate a practice but not being able to afford/locate a physician willing to sign a written agreement. We have also heard from community health centers, hospital systems, and other institutions who would hire extra physicians only to maintain the ratio of 4 NPs to 1 physician (when not physically located at the same practice location as current statue requires). Consistent with NP practice, and federal requirements for Medicare reimbursement, the law recognizes the collaboration that exists among health care professionals. Thus, it is important to understand the details of the new law.

HIGHLIGHTS OF THE NEW LAW Newly licensed Nurse Practitioners with less than 3,600 hours of practice continue to be subject to current requirements, including: Maintaining a Written Practice Agreement (WPA) signed by the NP and physician Identifying practice protocols approved by the State Education Department Chart reviews For Nurse Practitioners with greater than 3600 hours of practice(approximately 2 years full-time), regardless of the NP's specialty (ie Acute, Adult, Family, Mental Health, etc...): No signed written practice agreement is required  No practice protocols need to be identified   NP shall maintain collaborative relationships Collaborative relationships.  Are consistent with Medicare's billing requirement about NPs and collaboration In New York, this means: NP communicates with licensed physician(s) as needed OR a Hospital that provides services through licensed physicians qualified to collaborate in the specialty involved and having privileges at such institution: by phone or in writing to exchange information  (two way street)  in order provide comprehensive patient care make referrals as necessary SED Attestation Form (To be developed prior to January 1st, 2015) An attestation form will be maintained in the NP's files, and is NOT filed with SED.  The NP attests that they hold one or more collaborative relationships (Law does not require identifying physician names/license numbers and no signatures are required Will include a dispute resolution process Dispute resolution process is established by NP and physician, but, if conflict, physician prevails (consistent with existing law. The NP always has the option of consulting with another physician). The NPA intends on working with SED on the form development NPs also to maintain evidence of such collaborative relationships For example, throughout the course of a patient encounter, should the NP need to consult with a physician, the NP may document the discussion in the patient record. This is one form of evidence of a collaborative relationship. This type of record keeping is not required for all encounters, only necessary for purposes of showing compliance with requirement of "collaborative relationships," as needed. NP to produce attestation form/collaborative relationship evidence upon SED's request Failure to do so is considered professional misconduct This is consistent with midwives' statute There will be Data Collection and a Report on the NP Profession Issued SED to collect data about profession and availability of NPs as part of triennial certification process Similar to physician data collection De-identified information posted to website SED to issue the report to the Legislature by September 1, 2018 NPMA Effective Date: January 1, 2015 Sunset NPMA will expire on June 30th, 2021, in order to provide opportunity to revisit, and determine further expansions This is NOT a demonstration project. The NPA will continue to work with all stakeholders throughout the time period to recommend enhancements as needed.